Nursing home beds are becoming harder to find as America ages. In this episode, Melissa Brown, COO of Gravity Consulting, explains the affordable alternatives, from PACE programs and in-home care to passive monitoring technology that can reduce falls and flag health issues early.
Jeffrey Snyder, Broadcast Retirement Network
Well, Melissa, it’s so great to see you. Thanks for joining us on the program this morning.
Melissa Brown, Gravity Consulting
Thanks so much for having me.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, we’re so glad to have you. You know, coming at this from a lay person, we’re very interested in what’s happening in nursing homes around the country. Clearly, there’s a need for caregiving.
Let me start with a basic question here. What are some of the current challenges that many nursing homes in America are facing?
Melissa Brown, Gravity Consulting
I think the biggest challenge that we’re facing right now is the squeeze. So from a regulatory perspective, from all the fines and the challenges nursing homes face, there is a kind of bleak future for them. And a lot of them may struggle to be successful as we move ahead into the next five to 10 years, which reduces the access for the common consumer.
And our biggest concern is, as we are well into the silver tsunami, and more importantly, the oldest baby boomer just turned 80, I believe, recently, we are really facing access issues, even on the private side, in assisted living and independent living, there is not going to be enough supply. And that is the biggest concern as we move forward.
Jeffrey Snyder, Broadcast Retirement Network
And thanks for that. And what’s being done, let me, as a follow up to that, what’s being done at the federal, state, local level to address that? I have to imagine that between the private industry and the federal government and local governments, that people are stepping up to try to address this.
They have to see this.
Melissa Brown, Gravity Consulting
It’s really interesting. In my opinion, I believe that our government and Medicare are trying to restrict the growth of nursing homes because it’s coming out of their pocket. It is their cost between Medicare and Medicaid.
It’s primarily funded by the government. And they’re never gonna say this out loud, but everything they’re doing shows that that must be their intention. And so we should see a shrinkage, not growth in nursing homes over time.
What this means for the consumer is that they’re privatizing senior living. All the other levels of care pretty much are paid privately. And so a senior of today really needs to be aggressive in their long-term care planning to make sure they have enough resources set aside that they will be able to get and pay for that care privately since it is both moving into homes and also moving more into the private sector in assisted living and other levels of care.
Jeffrey Snyder, Broadcast Retirement Network
So let me ask you, I mean, this isn’t an issue just for affluent people. What if you’re someone of modest means? What can you do?
How can you save for retirement, but also for your caregiving needs?
Melissa Brown, Gravity Consulting
Yeah, I think when it’s reasonable, moving in with a loved one is the ideal scenario if your means are modest. But there are other options as well, because let’s be honest, most people in the boomer generation and their children, that’s not really what people are looking for today. People want independence, and we tend to not live in the same communities anymore.
We’re often states away. And I think it’s not ideal to move a senior somewhere where they don’t have any community. So the real solutions are in community-based services that we don’t always think of and consumers aren’t always aware of.
One of them is called a PACE program. Now this only applies if you are Medicaid eligible, but it’s essentially adult daycare plus therapists, plus doctors, transportation to and from the program. You’re there all day long.
So if you’re living with a loved one who has to be out of the home during the day, and it’s difficult for you to be on your own, this is a great program solution. And some of these other communities, like you’re talking about the aging in place, the really savvy senior living providers out there are starting to expand into home and community-based services so whether they’re providing skilled home health, which is covered by Medicare traditionally or your other main payers, or the private pay home care. Sometimes all people need is a couple hours in the morning and a couple hours in the evening of oversight and care for it to be realistic for them to stay home another extra couple of years.
And the cost for that is so much less than traditional senior living. And I think the biggest unsung hero solution out there might just be adult daycare, which I don’t love the term of, I really think it’s an industry we need to change that, but that’s what it’s called right now. And essentially it’s just a place that a senior can go to during the day to get food, meals, socialization, activities, and just someone to make sure that they’re okay, somebody that’s gonna know if they’re not.
So I think those are great solutions. And the last thing I’d add to that is technology. There are incredible AI platforms out there that put passive remote patient monitoring into the patient’s home.
So really things like motion sensors and things like that, that you don’t even know are there once they’re there. It learns your normal pattern and it alerts your next point of contact if something starts happening out of the ordinary. That is the least cost or the lowest cost way to help you expand the amount of time you’re able to stay in your home.
Jeffrey Snyder, Broadcast Retirement Network
Well, I know you live in Pittsburgh, Pennsylvania, obviously in the great Commonwealth. I live in North Carolina. You mentioned before some of the community-based services.
If I live in any state, how would I find out what types of services are available to me in my community?
Melissa Brown, Gravity Consulting
I think your best resource today is AI or ChatGPT. Even Google Gemini can sometimes be a great source. I like to, when I’m researching potential options out there like this, I like to kind of pit them against each other.
What does Claude tell me? What does ChatGPT tell me? What does Google Gemini tell me?
And just ask them, we’ve talked about several specifics, ask them what else is out there that’s like this? Who’s providing it? Who has a waiting list?
Who has availability? Some of that is publicly available. Some of it you’re gonna have to make the phone calls and do things the old-fashioned way to get those answers.
But the best time to get on a waiting list is today, not three to six months from now when you desperately need that care. So get on the waiting list ahead of time. So when you need it, you’re next in line.
Jeffrey Snyder, Broadcast Retirement Network
So is the future really what we see? I wanna talk about AI for a second. Is the future really what we see on commercials where someone, I’ve seen a lot of commercials where there’s a mature woman talking to ChatGPT, I think.
Is that really the future here for those of us who maybe wanna live at home, age at home?
Melissa Brown, Gravity Consulting
I mean, those kinds of things are great solutions. I think about all the smart home things like opening and closing blinds, turning on and off lights, being able to make a phone call for you if you’re in danger. We find, you know, Alexa, there’s a lot of research out there that Alexa and the Google Assistant, other devices like that, just people talking with them every day really reduces the signs and symptoms of loneliness and isolation.
But the technology that I was referring to, there’s a couple of different brands out there. Zempli is one, Amba is another. Essentially, they come into your home and they set up multiple sensors.
So you get a sensor underneath your mattress and you pair that with something like the Alexa so that in the middle of the night, when you get up, it turns on and Alexa says, hey, Melissa, could you just count to 10 for me before you stand up? And they’ve proven a dramatic reduction in falls just by that one, you know, interaction together. They also put a monitor or a mat on your chair and then you put these passive motion sensors all throughout the home.
And so it’s taking note of your activity and they refer to it as activity as the sixth vital sign. So it’s paying attention to how often are you going to the bathroom? How long did you stay in bed?
How many times did you open your fridge? Did you open the cabinet that has your medications in it? And if there’s deviations from your normal pattern, that’s where AI is learning what’s your normal pattern and then identifying anything that’s a significant enough of a deviation that it might indicate something.
For example, you get up to use the restroom twice at night. The last three nights in a row, you’ve gotten up six times average a night. That probably indicates that you have a UTI where you might not have any other symptoms activated yet.
And just that little bit could get us in and get you the antibiotic or the care that you need to help avoid that turning into something that ends up in sepsis and in a nursing home admission and all of those sorts of things that we would try to avoid.
Jeffrey Snyder, Broadcast Retirement Network
And you were describing some passive technology, monitoring technology. Is that cost-effective? Is it at scale?
Can someone of modest means acquire that technology?
Melissa Brown, Gravity Consulting
Absolutely anyone can really access it. I think even if you’re on a fixed income, you can. This is the kind of thing that costs tens or hundreds of dollars a month at most.
It is not a huge cost. And we really recommend senior living providers consider using it. We did a study for Xempli a couple of years ago.
They put it in assisted living, two floors, one on top of the other. So it’s the same community, the same staff, the same oversight. And we allowed people to self-select.
Do I wanna use Xempli or do I not? So whoever chose to use it did. They were seven times more complex than the ones who chose not to based on all the diagnoses they have.
And we reduced falls by nine times, nine fold fall reduction in that group and a significant increase in the identification of UTIs in that group as well. So it’s really a great option for people to consider on the senior living side as well. It obviously helps them meet their goals and keep patients healthier longer, which is just good business.
Jeffrey Snyder, Broadcast Retirement Network
And my last question for you, and I probably should have asked this before, but are there other societies that you can look to beyond the United States? Obviously we’re very unique in terms of how we operate in terms of our healthcare system, but are there any other societies around the globe that we can look to or you can look to that provide hope or provide maybe some learning experience for the United States?
Melissa Brown, Gravity Consulting
I think the most interesting thing we can learn from around the globe is something that all of us as Americans know. Our diet is a huge part of the problem. They’re referring to Alzheimer’s as being diabetes type three at this point.
And even in the projects that Gravity is building and owning and operating for ourselves right now, we are highly invested in a European pantry menu. The idea being that people in Europe eat a lot of the same types of foods and macros that we do, but because they’re not as processed because of the GMOs being different there, et cetera, they’re able to live longer, healthier and stay independent longer than a typical American. And so I think thinking about our diet, not just individual seniors living in their homes, but us as a senior living industry, I think we do a great job with that on the independent living side.
And I think it starts to fall short on many cases on assisted living and it’s really not what we need it to be in most nursing homes. So I think there’s a huge opportunity for us to approach this from a new way. And I believe based on some of the other research that’s been done, we’ll be able to show an increased length of stay, increased life once somebody does get to assisted living or the nursing home, because we’re helping to avoid some of these dietary issues.
Jeffrey Snyder, Broadcast Retirement Network
Well, Melissa, it’s so great to see you. Thanks so much for joining us. Really appreciate you sharing your expertise and we look forward to having you back on the program again very soon.
Melissa Brown, Gravity Consulting
Really appreciate it. Thanks so much.
